Top Seven AIDS Policy Issues Facing the New Administration

January 15, 2009—The historic election of President-elect Barack Obama heralds an era of new leadership in the fight against HIV/AIDS. As the new administration begins its work, amfAR has identified a number of critical policy priorities that must be addressed:

1. Develop and implement a national AIDS strategy for the U.S.The President’s Emergency Plan for AIDS Relief (PEPFAR) requires that nations receiving the program’s funds develop comprehensive national plans to fight AIDS. Yet the U.S. lacks its own plan, despite the fact that more than one million Americans are now living with HIV/AIDS and 56,000 more are infected with HIV annually. In our nation’s capital, 1 of every 20 people is infected with HIV.

A national AIDS strategy can serve as operational tool and roadmap for the federal government, but it will require bold leadership, an innovative approach, and buy-in from a range of stakeholders. The new administration must also decide who will coordinate this plan and whether to reopen the doors of the White House Office of National AIDS Policy.

2. Increase investments in research.President-elect Obama has pledged to increase our national investment in scientific research, which is the foundation of effective public health and medical interventions, an engine of societal progress, and a cornerstone of innovation for the American economy. To this end, the new administration must decide whether and at what amount to include research and science in the stimulus package pending Congress as well as to what degree to increase NIH and other research funding for FY 2010.

3. Emphasize the power of prevention.
For every person treated for AIDS, 2.5 people will become newly infected worldwide. That is why prevention is critical to stemming the tide of the epidemic. Discovering new prevention techniques and determining novel ways to effectively implement existing strategies must be a top priority for the Obama administration. Increased prevention funding is required to help communities most at risk for HIV. Since an estimated 23 percent of all people with HIV in the U.S. do not know they are infected, more funding is needed to expand HIV testing and education. Additionally, greater emphasis must be placed on developing safe and effective topical microbicides and a vaccine; implementing cervical barriers and male circumcision, where appropriate; and studying chemoprophylaxis interventions, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). The new president must craft a healthcare agenda that incorporates evidence-based preventive interventions and comprehensive sex education as opposed to abstinence-only education.

4. End the federal syringe exchange ban.
An estimated one to two million Americans inject illegal drugs, and approximately one-fifth of all reported HIV/AIDS cases in the U.S. are attributable to injection drug use. Scientific evidence has found that syringe exchange programs (SEPs) reduce the risk of transmission of HIV and other blood-borne diseases. The Obama administration must consider removing the federal barriers to funding SEPs and related harm reduction services both domestically and globally.

5. End the HIV travel and immigration ban.
Current U.S. regulations bar people living with HIV/AIDS from entering the U.S. as visitors or immigrants. Additionally, legal immigrants who contract HIV while in the country are not eligible to become permanent residents. These restrictions represent a major obstacle to reducing the stigma that is associated with HIV. President-elect Obama’s leadership is required to ensure that the U.S. Department of Health and Human Services removes HIV/AIDS from the list of communicable diseases that prevent entry into the U.S.

6. Provide access to high-quality and comprehensive healthcare.
People with HIV/AIDS are disproportionately affected by lack of access to high-quality, affordable, and comprehensive healthcare. In the U.S., at least one-fifth of those living with HIV are uninsured. The administration’s broader healthcare reform efforts must ensure that people with HIV/AIDS have access to early treatment and care. This will involve expanding and strengthening the foundation of public health programs such as Medicaid and Medicare while continuing to offer services through Ryan White programs. Healthcare reform should guarantee access to affordable healthcare, address economic disparities, require accountability and transparency, emphasize disease prevention, and foster innovation.

7. Strengthen global AIDS programs.
Currently, there are 33 million people infected with HIV globally, and more than two million people die from AIDS annually. U.S. assistance for global prevention, treatment, and care programs helps to decrease the number of new infections, improves access to necessary treatments for those living with HIV, and increases the economic stability and security of countries severely affected by the disease. The new president must advance PEPFAR and other global AIDS programs with policies including comprehensive sex education, harm reduction, and evidence-based prevention strategies.

By effectively addressing these seven issues, the Obama administration can usher in a new era of HIV/AIDS policy, with real hope for meaningful progress in our nation’s efforts to combat the epidemic in the U.S. and around the world.